To the Editor:

I am grateful to Drs. Roth and Lazris for their article on racist clinical documentation and the medical one-liner.¹ They state that although medical education traditionally called for the inclusion of race in the history of present illness, this practice must be unlearned due to its effects on stereotyping and bias, suggesting that bias is merely a downstream effect of racial labels. However, the very use of racial labels in the history of present illness is itself an expression of bias.

White people are less likely than Black people to receive a racial descriptor in the medical one-liner,² which suggests that unconscious bias drives the inclusion of race. The absence of racial labels for White individuals reveals assumptions of White as the “default race,” whereas the relatively higher prevalence of racial labels for Black individuals reveals a tendency to regard them as “other.” Black clinicians are also less likely to document race in the history of present illness than White clinicians,² indicating the role of unconscious bias in prompting mention of a patient's race. In fact, some medical schools now actively educate students against using race in the medical one-liner.³

The consequences of using racial labels include not just propagation of bias but also medical errors, such as missing a sickle cell disease diagnosis in those of Indian ancestry and failing to consider cystic fibrosis in Black patients.^4,5

We need to stop including race in the medical one-liner. It biases us and our medical decision-making.

Editor’s Note: This letter was sent to the authors of “Avoiding Racist and Judgmental Clinical Documentation: Helping to Achieve Health Equity,” who declined to reply.